In bipolar disorder, SSRI monotherapy should be avoided; treatment often involves combining an antidepressant with mood stabilizers or antipsychotics.

In bipolar disorder, SSRI monotherapy should be avoided; treatment often involves combining an antidepressant with mood stabilizers or antipsychotics.

• A. SSRI monotherapy is fine
• B. A combination of antidepressants such as an SSRI, plus a mood stabilizer, which includes anticonvulsants (Lamotrigine, Divalproex), atypical antipsychotics (Quetiapine) – as typical antipsychotics increases risk of QT prolongation, or Lithium
• C. Antidepressants are never used in bipolar disorder
• D. SNRI monotherapy is preferred

Answer: (B)

When treating bipolar disorder, antidepressants are not used alone because they can trigger mania or rapid mood cycling. The safer, more effective approach is to use an antidepressant only in combination with a mood stabilizer or an antipsychotic. This pairing helps lift depressive symptoms while keeping mood stabilized and reducing the risk of a manic switch. A practical way this is done is by adding an antidepressant such as an SSRI to a mood stabilizer like lithium or valproate, or to a mood-stabilizing/anticonvulsant option such as lamotrigine. An atypical antipsychotic like quetiapine can also be used in combination to support mood stabilization and manage depressive symptoms. This contrasts with using an antidepressant on its own, which is less safe in bipolar disorder due to the risk of triggering mania. Typical antipsychotics are avoided when possible because they can increase the risk of QT prolongation.

When treating bipolar disorder, antidepressants are not used alone because they can trigger mania or rapid mood cycling. The safer, more effective approach is to use an antidepressant only in combination with a mood stabilizer or an antipsychotic. This pairing helps lift depressive symptoms while keeping mood stabilized and reducing the risk of a manic switch.

A practical way this is done is by adding an antidepressant such as an SSRI to a mood stabilizer like lithium or valproate, or to a mood-stabilizing/anticonvulsant option such as lamotrigine. An atypical antipsychotic like quetiapine can also be used in combination to support mood stabilization and manage depressive symptoms. This contrasts with using an antidepressant on its own, which is less safe in bipolar disorder due to the risk of triggering mania. Typical antipsychotics are avoided when possible because they can increase the risk of QT prolongation.